In a previous paper on general and focal symptoms localization in the brain was discussed as to its principles and limitations. In the subsequent investigations a method of examination has been worked out and is here presented. It is meant to serve a threefold purpose, which should be kept in mind when the scheme is applied.

The circulatory factor in the pathogenesis of mental disorder can be dealt with in at least two different ways. The exposition can be narrowed down to a mere description of what we know for certain about the psychiatric significance of circulatory disturbances. On the other hand, I think it not less legitimate to look at the question as a highly fascinating problem, the full bearing of which upon psychiatry we are only just beginning to discern as a dim shape on the scientific horizon.

Irritability is used in this paper in its popular sense as “the quality or state of being easily annoyed or excited to anger”, according to the definition of the Oxford English Dictionary. I leave it an open question how far other meanings of the word—especially “the condition of being excessively or morbidly excitable by or sensitive to the application of an external stimulus”—have anything to do with the definition of irritability as an affective state. A detailed description of the specific emotional quality of irritability would be of little help to someone who had never experienced it. Irritability might be characterized by its accelerated time factor (in contrast, e.g., to sadness, with its slow time factor), by its tension and proneness to release in outward expressions, and by its unrest. But all such characteristics are only descriptions of the same happening looked at from different angles.

In the routine examination of the urine of patients admitted to this hospital one is struck by the frequency of albuminuria. For example, 27·4% of 667 consecutive female admissions had a trace of albumin in the urine (i.e., a faint cloud appeared when the heat test was applied), while 37·2% had more marked albuminuria (i.e., the urine showed a thick cloud when the heat test was applied); only 35·4% were entirely free from albuminuria. Of 517 consecutive male admissions 20% had a trace of albumin in the urine, 19·5% more marked albuminuria, and 60·5% were free from albuminuria. B. H. Shaw (1) at Stafford found even higher percentages in his 250 admissions in 1935.

One of the most striking characteristics of patients in a mental hospital diagnosed as suffering from schizophrenia, or dementia præcox, is their dissimilarity. It is easy to pick out cases in which the onset, course, symptomatology and outcome of the psychosis are different. There is thus a tendency to regard the schizophrenic group as possibly containing many different clinical entities. One of the current major problems of psychiatry is to clarify what constitutes schizophrenia and to subdivide the clinical material further in a way which will prove useful for study.

A brief summary of this patient's condition was given in our article on “Hypnosis in Mental Hospital Practice “(1), where it was cited as Case 2, illustrating “the great value of hypnosis as a quick method of bridging amnesic gaps”. The hope was there expressed that the case would be published separately in full, as it contains numerous features of general interest. Similar cases appear from time to time in the newspapers, and it seemed to us that a detailed account, showing exactly how the amnesias arose and how the case was dealt with, might be welcomed.

The observations recorded in this paper form part of an investigation into the mineral constituents of the central nervous system both in normal and pathological conditions.

I have been asked to speak to you about the psychological implications of functional circulatory disorder. Unfortunately there is no generally recognized system of the functional disturbances of the circulation. For this reason, and also for want of time, I shall be able to deal only with a few sections of the problem.

Provision for the observation of cases of mental disturbance occurring in the administrative and the user area of the Liverpool Corporation is made in one of the city institutions, Smithdown Road Hospital. In this large general hospital are located two special divisions, containing 180 beds, one for female and one for male patients, and to the wards of these divisions are receivable all cases of attempted suicide occurring in Liverpool.

IN 1935 V. V. Issahyev reported very favourable results from the treatment of a number of cases of idiopathic epilepsy by diathermy to the head, stating that although the method could not be held to cure the complaint, nevertheless it produced considerable relief in the majority of cases. The object of the present investigation has been to repeat this form of treatment in a further series of cases in order to see how far these results could be confirmed.

The clinician's share in a discussion on psychoses of circulatory origin must be to provide, in the first place, a description of the characteristic clinical pictures. This would mean the enumeration of a rather puzzling variety of observations, among which it has until lately been rather difficult to find any systematic order. One could scarcely add very much to the classical chapter on arteriosclerotic psychoses in Kraepelin's text-book. Since, however, Dr. Krapf has singled out the hypertensive psychoses as a special group, the task is no longer one of pure description. The application of the achievements of general medicine to the field of hyperpiesis should have opened new aspects in cerebral vascular disease. Supplementing the fundamental ideas given in Dr. Krapf's own paper, I propose to give you a more detailed survey, with some illustrations.

The case reported here concerns the suicide of a voluntary patient and a subsequent claim for damages for “negligence, breach of contract and warranty”, which, after many delays, was struck out of the Assize List on account of the non-appearance of the plaintiff.